State Actions to Sustain Medicaid Long-Term Services and Supports During COVID-19

Appendix Table 1:   Medicaid Emergency Authorities
Authority Description Start Date End Date
Disaster-Relief SPA Allows states to make temporary changes to address eligibility, enrollment, premiums, cost-sharing, benefits, payments, and other policies differing from their approved state plan during the COVID-19 emergency. States may not make changes that restrict or limit payment, services, or eligibility or otherwise burden beneficiaries and providers. 1/1/20 (using Section 1135 waiver authority) or later date elected by state End of public health emergency or earlier date elected by state
Traditional SPA Allows states to amend their Medicaid state plans, which govern program elements such as coverage groups, covered services, provider reimbursement methodologies, and administrative activities. 1st day of quarter in which SPA is submitted to CMS or later date elected by state Continues until subsequently amended or terminated
HCBS Waiver Appendix K Allows state to amend Section 1915 (c) or Section 1115 HCBS waiver provisions related to eligibility, services, payment, provider qualifications, level of care evaluations, person-centered service plans, incident reporting, settings, and other policies to respond to emergency. 1/27/20 or later date elected by state and approved by CMS 1/26/21 or earlier date elected by state
Section 1115 Demonstration Waiver Allows states operate to Medicaid programs without regard to specific statutory or regulatory provisions to furnish medical assistance in a manner intended to protect, to the greatest extent possible, the health, safety, and welfare of individuals and providers who may be affected by COVID-19. 3/1/20 or later date elected by state and approved by CMS 60 days after public health emergency ends or earlier date approved by CMS
Section 1135 Waiver Allows states to operate Medicaid programs without regard to certain fee-for-service prior authorization, LTSS authorization and assessment, fair hearing procedural and timeline, provider enrollment, reporting and oversight, and other requirements, to ensure that sufficient health care items and services are available to meet enrollee needs and that providers are reimbursed. 3/1/20 End of public health emergency, per CMS guidance
SOURCE: KFF analysis of Medicaid emergency authorities and CMS guidance.
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